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Overcoming Addiction: Paths toward recovery

Addiction can be devastating. Recent scientific advances have shaped our understanding of this common and complex problem. The good news is that there are a number of effective treatments for addiction, including self-help strategies, psychotherapy, medications, and rehabilitation programs. You can use the strategies presented in this report to discover new ways to cope with life’s difficulties.

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Nationwide, nearly one in 13 people over the age of 12 has a drinking problem. Millions more engage in risky drinking behaviors that jeopardize their health, relationships, productivity, and general well-being. This report explores the many factors to consider when deciding how much (if any) alcohol is safe for you. It also details the dangers of alcohol misuse, from drunk driving to chronic, life-threatening health conditions.

Addiction can be devastating. One of the most common expressions of addiction, alcohol dependence, causes an estimated 100,000 deaths annually — the equivalent of an airliner carrying 274 passengers crashing every single day. The good news is that there are a number of effective treatments for addiction, including self-help strategies, psychotherapy, medications, and rehabilitation programs, all of which are detailed in this report. You’ll also find targeted advice on specific types of addiction, as well as information about coping with a loved one’s addiction.

More good news: several scientific advances have shaped our understanding of this common and complex problem. For example, brain-imaging technologies have revealed that our brains respond similarly to different pleasurable experiences, whether derived from psychoactive substances, such as alcohol and other drugs, or behaviors. Genetic research has uncovered that some people are predisposed to addiction, but not to a specific type of addiction. Finally, medications developed to treat one addiction have, in some cases, proven helpful for treating a different type of addiction.

You can protect (and heal) yourself from addiction by having diverse interests that provide meaning to your life. Understand that life’s problems usually are transient, and perhaps most importantly, acknowledge that life is not always supposed to be pleasurable. Therefore, you don’t have to use a psychoactive substance to get away from the negative things that happen in life. Instead, you can use the strategies presented in this report to discover new ways to cope with life’s difficulties.

This Special Health Report was prepared by the editors of Harvard Health Publications in consultation with Faculty Editor Howard J. Shaffer, Ph.D, C.A.S., Director of the Division on Addiction at the Cambridge Health Alliance and Associate Professor of Psychology in the Department of Psychiatry at Harvard Medical School. 49 pages. (2011)

The problem of addiction

What is addiction?

Substance dependence

Substance misuse and abuse

An impulse problem?

Understanding tolerance, physical dependence, and withdrawal

The use continuum: From harmless to harmful

Cultural context

How people develop addiction

Risk factors for addiction

A common brain pathway

Dopamine differences

Drug, set, and setting

How addiction affects the brain

The shift toward addiction

Recovering from addiction

Natural recoverers

Are you ready to change?

What, why, when, and how?

Seeking treatment

Acknowledge your ambivalence

Working with a therapist

Nicotine

Alcohol

Prescription drugs

Illegal drugs: Marijuana, cocaine, and heroin

Gambling and other behavioral expressions of addiction

SPECIAL BONUS SECTION: Gender and age differences in addiction

When a loved one has addiction

Resources

Glossary

Are you ready to change?

If you have addiction and you’d like to change your behavior, consider all the costs and benefits of the choices you could make. Don’t think only about the negative aspects of your object of addiction; think, too, about the benefits it offers. One important step to recovery involves understanding what you get from your substance or activity of choice, and how you might achieve the same benefit through other, less harmful means. Experts recommend doing an impromptu cost-benefit analysis by filling out a table such as Table 1.

The example here addresses the issue of compulsive gambling, but it could be repurposed for any addiction. You can make a chart using your own addiction and your own costs and benefits on a blank piece of paper. When you fill it out, write as many items as you can think of to go under each heading. Weigh the importance of each answer. Do the benefits of continued use or participation outweigh the costs? If not, you may decide you want to change your behavior.

Is it worth the cost?

Benefits of not gambling

Benefits of gambling

I would have more money to spend on other things.

I would have more time to spend with people I care about.

My friends and family would probably be happier with me.

I have fun when I gamble.

I love the feeling of excitement when I gamble.

I have occasionally won lots of money gambling.

Costs of not gambling

Costs of gambling

I would have to face the responsibilities I’ve been ignoring while engaged in my addiction.

I would have to somehow fill up my time.

I would lose my social connection to my gambling buddies.

I am heavily in debt.

I am depressed and anxious.

I have angered my friends and family.

What, why, when, and how?

If you decide to make a change, you’ll have to sort out exactly what, when, and how you want to change. That will depend a lot on your view of the problem. Those who are most invested and motivated to change will have the best chance of success.

Assuming you want to make a change, the next step is to choose your goals. Ask yourself:

When do I want to make a change?

Do I want to stop altogether or do I want to simply cut down?

If you decide you want to cut down, determine the level to which you want to limit your use or participation and be specific. As with any behavior change, you might find the following “SMART” goals helpful. Your goal should be

Specific, meaning you should set a specific goal, such as, “I will stop drinking any alcohol between the hours of 1 a.m. and 10 a.m.”

Measurable, meaning that your success should be easy to quantify. In the case of the goal mentioned above, you might keep a log of your consumption to be sure that you adhere to your goal.

Achievable, meaning your goal should be something you are physically capable of doing today, and something that would be safe for you to do. If you drink chronically, round-the-clock, the sample goal might not be safe without the help of a doctor, because the interruption in drinking could bring on life-threatening withdrawal consequences.

Realistic, meaning that it is something you believe you can do.

Time-based, meaning that you should set a date and time when you start the goal, and you should examine your progress at regular intervals.

Change is a gradual process and takes time. The first three to six months of change are usually the most difficult. The period after that will be hard, too, but not quite like it was in the beginning. If you get discouraged, remember that others before you have overcome addiction.

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